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Cutting child abuse in Colorado by half will require home visits, network of help

Erica Lim, 20, embraces her 1-year-old daughter, Suryn, during a visit from Allison Wilder, of Nurse-Family Partnership, at their Aurora home.
Erica, who was 19 when she had her baby, said she appreciates the program. (Craig F. Walker, The Denver Post)

Colorado's plan to reform the child- welfare system and significantly reduce child abuse and neglect includes sending social workers and nurses into the homes of at-risk families and providing a network of help — ranging from teaching parents about safety hazards to helping them find jobs.

One of the programs, SafeCare, is for families who have been reported to child protective services and have children 5 years old or younger, the age group that accounts for 75 percent of abuse and neglect cases.

The Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, which is partnering with the state to set up SafeCare, has a goal of reducing child abuse and neglect in Colorado by half within seven years.

Colorado also plans to expand a program for young, first-time mothers who have never been accused of abuse. The Nurse-Family Partnership sends nurses into young moms' homes to counsel them on everything from budgeting to coping with diaper rash.

And the state is beginning a "community response" program with sites across the state that will help at-risk families find child care, jobs, counseling and other help.

Reducing child abuse by 50 percent is ambitious, but Kempe Center director Des Runyansaid it is achievable. The rate of domestic violence in this country has dropped by 64 percent since 1994, according to a Department of Justice report.

"This state has not done what some other states have done thinking about prevention comprehensively," he said. "We need to get to people before they fall in the river."

SafeCare, led by Georgia State University, has been successful in other states. A University of Oklahoma study found a 26 percent reduction in repeat child-abuse complaints for families who participated in SafeCare compared with those who did not. A Kempe Center team will help run the program, which will train social workers to work with up to 10 families at a time for 20 weeks each.

Allison Wilder of the Nurse-Family Partnership catches up on paperwork between visits to homes. Partnership nurses collect data on clients, charting participation, outcomes and a host of other variables that become part of the information supporting this evidence-based, peer-reviewed program. (Craig F. Walker, The Denver Post)

The Kempe Center plans to track child-abuse rates in Colorado through an anonymous survey beginning this spring. The telephone survey will ask parents how they discipline their children — from yelling and timeouts to kicking, choking and hitting with an object.

Similar studies in North Carolina revealed 25 percent of parents spank 9-month-olds and 6 percent spank 3-month-olds. Anonymous surveys typically show child abuse is 10 to 20 times higher than what is reported to child- protection services, Runyan said.

Colorado's child-welfare system received about 11,000 substantiated abuse and neglect reports in 2011.

Young mothers and mothers with minimal education are at higher risk of abusing and neglecting their children, Runyan said. And while men are more often accused of fatal abuse, mothers are more likely to shake babies and inflict harsher punishment, he said.

Young, low-income and single moms are exactly the demographic the Nurse-Family Partnership works with.

The NFP, developed by David Olds, who is now director of the Prevention and Research Center for Families and Child Health at the University of Colorado, is used in 50 of the state's 64 counties.

Colorado's prevention initiative wouldn't expand the program, said Lisa Merlino, executive director of Invest in Kids, which helps implement the NFP in Colorado. Instead, it would allow the program to develop a new element, one that could spread to the other states and countries where the NFP is in use.

Over several decades and in multiple studies, the NFP has been found to significantly reduce instances of child abuse.

But it's not perfect.

Occasionally, a nurse suspects child abuse or neglect and has to report a client, or someone in the client's household, to social workers.

Under the state's expanded prevention plan, nurses in that situation would work with county social workers, and the effectiveness of that collaboration would be tracked, Merlino said.

"We'll be increasing the local child- welfare collaboration with NFP nurses in cases where the nurse believes that maltreatment is imminent or has occurred," said Merlino.

The NFP probably will benefit from additional money this year, though. During recent state budget cuts, the program's funding stagnated. Merlino said she believes modest annual funding increases will be restored this year. In addition, the program will benefit from provisions of the federal health-care law that provided money for home-visitation programs nationwide.

Gov. John Hickenlooper and state human-services director Reggie Bicha announced the latest child-welfare reforms last week — a statewide hotline, training for "mandatory reporters" of child abuse and uniform procedures for screeners of abuse calls. The plan calls for $20 million in requests for state funds from the legislature. The state also expects to receive $8 million in federal funds in each of the next five years — money freed up by a federal waiver that gives Colorado more flexibility in how it spends child-welfare funds.

State officials have not determined yet how much of the money will go toward abuse-prevention programs.

The Kempe Center hopes to set up SafeCare in three county child-welfare departments the first year and add three counties each year. Two social workers at the Kempe Center already are trained in SafeCare and work with Denver County.

The state human-services department intends to open 18 community- response sites within six years. When a county child-welfare department "screens out" a child-abuse call because there is not substantial cause for concern, a caseworker can refer the family to a community-response site that will link them to help finding financial and counseling services, said Julie Krow, director of the state Office of Children, Youth and Families.

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